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103 Cards in this Set

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A nurse teaches a patient about diabetes, and the symptoms of hypoglycemia and ketoacidosis. The patient demonstrates understanding of the teaching by stating that a form of glucose should be taken if experiencing which of the following symptoms?

a. Shakiness
b. Blurred vision
c. Polyuria
d. “fruity” breath odor
A – shakiness.

Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A “fruity” breath odor, blurred vision, and polyuria are signs of hyperglycemia.
A nurse is teaching a patient w/ GERD about foods that cause the condition. Which of the following foods would increase the lower esophageal sphincter pressure (LES)?

a. Alcohol
b. Oranges
c. Nonfat milk
d. Chocolate
C – nonfat milk

The most common cause of GERD is excessive relaxation (decreased pressure) of the LES, which allows the reflux of gastric contents into the esophagus. Foods that increase LES pressure will decrease the reflux and lessen the symptoms of GERD. Alcohol, citrus fruits (oranges), and chocolate decrease LES pressure.
A nurse is caring for a patient admitted for hypotension, dizziness, weakness, and syncope. The patient’s vital signs are; BP=76/54, P=50, R=22, T=98.0. Which of the following drugs should the nurse administer to the patient?

a. Amiodarone
b. Amlodipine
c. Atropine
d. Digoxin
C. Atropine

In sinus bradycardia, sinus mode discharge rate is less than 60 beats per min.

Syncope, hypotension, weakness, and dizziness is common and if the patient is experiencing any of these symptoms and the underlying cause isn’t determined, treatment of choice is atropine to increase the heart rate to about 60 beats/min.
Type of drugs that help improve bronchial airflow by increasing bronchiolar smooth muscle relaxation

a. Corticosteroids
b. Cholinergic antagonists
c. Leukotriene antagonist
d. NSAIDs
B. Cholinergic antagonists

Cholinergic antagonist drugs (Ipratropium) causes bronchodilation by inhibiting the parasympathetic nervous system, allowing sympathetic nervous system to dominate, releasing norepinephrine that activates beta2 receptors
Anti-inflammatories do not cause bronchodilation
A nurse is monitoring a patient at risk for hyperglycemic hyperosmolar state (HHS). Which of the following would indicate hyperglycemia on the patient and requires appropriate intervention?

a. Confusion
b. Tachycardia
c. Diaphoresis
d. Polyuria
D – polyuria

Classical symptoms of hyperglycemia are the 3Ps (polyuria, polydipsia, polyphagia). All the other options are signs and symptoms of hypoglycemia.
A nurse in the telemetry unit is caring for a patient with bradycardia. The patient was given atropine 0.5mg IV bolus. Which of the following is a side effect of the drug and requires proper nursing intervention?

a. Dry mouth
b. Nagging cough
c. Excessive bleeding
d. Nausea
A. Dry mouth

Atropine is an anticholinergic drug. Assess for urinary retention and dry mouth after administration
A nurse is preparing a care plan for a diabetic patient who has hyperglycemia. Which of the following nursing diagnoses is the priority for the patient?

a. Deficient knowledge
b. Anxiety
c. Imbalanced nutrition, less than body requirements
d. Deficient fluid volume
D – deficient fluid volume

An increased blood glucose level will cause the kidneys to excrete glucose in the urine accompanied by fluids and electrolytes, causing dehydration.
When doing an assessment on a patient w/ peptic ulcer disease, which of the following bowel sounds is initially present in the patient?

a. Normoactive
b. Hyperactive
c. Hypoactive
d. Absent
B – hyperactive

Physical assessment findings may reveal epigastric tenderness, and auscultation of the abdomen may initially reveal hyperactive bowel sounds, but these may diminish w/ progression of disorder.
Which of the following symptom is the most commonly reported in patients w/ peptic ulcer disease?

a. Dysphagia
b. Dysuria
c. Dyspnea
d. Dyspepsia
D – dyspepsia

Dyspepsia (indigestion), which is discomfort in the upper abdomen, is the most commonly reported symptom associated w/ PUD. It is typically described as sharp, burning, or gnawing.
A patient was admitted for fatigue, weakness, SOB, and palpitations. Patient’s medical history includes diabetes, hypertension, and CHF. The patient’s EKG reading shows disorganized rhythm with no distinguishable P waves. The patient was diagnosed with Atrial fibrillation, which of the following drugs should the nurse anticipate to administer?

a. Amiodarone
b. Atropine
c. Epinephrine
d. Furosemide
A. Amiodarone

Traditional interventions for A-fib include calcium channel blockers (diltiazem, amiodarone), and anticoagulants (heparin, coumadin)
A nurse is performing an assessment on a patient diagnosed w/ myxedema. Which of the following would the nurse expect to note on the patient?

a. Fine muscle tremors
b. Bulging eyeballs
c. Dry skin
d. Diaphoresis
C – dry skin

Myxedema is a sign of hypothyroidism. Symptoms include periorbital edema, dry skin, dry coarse hair, non-pitting edema on hands and feet. All the other options are noted on a patient with hyperthyroidism.
Which of the following is true regarding the drug Albuterol?

a. It causes bronchodilation by inhibiting parasympathetic nervous system, releasing norepinephrine that activates beta2 receptors
b. Onset of action is slow with a long duration
c. Requires a specific blood level to work
d. A fast-acting “rescue” drug
D. Albuterol is a short-acting beta agonist (SABA) primarily used as a fast-acting “rescue” drug either during an attack or just before engaging in activity that usually triggers an attack
A patient diagnosed with an A-fib is scheduled to have a cardioversion procedure. The nurse is performing patient teaching about the procedure. Which of the following drugs would the nurse anticipate the patient to take regarding the procedure?

a. Diuretic
b. ACE inhibitor
c. NSAID
d. Anticoagulant
D. Anticoagulant

Before elective cardioversion, the healthcare provider prescribes an anticoagulation therapy for about 6 weeks to prevent a thrombo-embolic event if the rhythm is successfully converted
The nurse is performing patient teaching about the causes of hypoglycemia on a patient recently diagnosed w/ diabetes. Additional teaching is needed if the patient identifies which of the following as a cause of hypoglycemia?

a. Decreased daily insulin dosage
b. Increased daily insulin dosage
c. Inadequate amount of fluid intake
d. Skipping meals
A – decreased daily insulin dosage

Causes of hypoglycemia include inadequate fluid intake, skipping meals, and increased daily dose of insulin.

Decreasing the daily insulin dose will lead to hyperglycemia.
An NG tube is placed on a patient w/ PUD. The nurse notices that the tube isn’t draining properly. Which of the following should be the nurse’s initial action?

a. Check for tube placement by checking pH of gastric contents
b. Notify physician
c. Request for an x-ray to confirm placement
d. Check the device to make sure it is working
D – check the device to make sure it is working

The nurse should first check that the NG tube is attached to suction and that the device is working properly.
During a routine checkup, the patient reported to her healthcare provider a new onset of intolerance to cold. Which of the following should the healthcare provider also assess regarding symptoms associated with hypothyroidism?

a. Weight loss and tachycardia
b. Increased respiration and HR
c. Diaphoresis and palpitations
d. Weakness and lethargy
D – weakness and lethargy

Weakness and lethargy are common signs of hypothyroidism. Other symptoms include weight gain, bradycardia, decreased respiratory rate, and dry skin.
A nurse in the acute care facility is about to teach a patient diagnosed with chronic bronchitis about the medication Prednisone. Which of the following teaching instructions by the nurse is not appropriate regarding administration of the drug?

a. Teach patient to avoid activities that can lead to injury
b. Teach patient not to take drug with food
c. Teach patient about numerous possible side effects
d. Teach patient to not suddenly stop taking the drug for any reason
B. Teach patient not to take drug with food

The drug should be taken with food to decrease the risk of GI ulceration
A patient diagnosed with an A-fib is scheduled to have a cardioversion procedure. The healthcare team is performing patient teaching about the procedure. Which of the following patient statement would need further teaching by the healthcare team?

a. “I will take an anticoagulant medication 4 – 6 weeks before the procedure”
b. “I will not receive supplemental oxygen during the procedure”
c. “I need to sign a consent form before going in”
d. “I can continue taking Digoxin to help prevent complications of A-fib”
D. “I can continue taking Digoxin to help prevent complications of A-fib”

Digoxin increases ventricular irritability and puts patient at risk for VF after the countershock. The drug is withheld for up to 48 hours before the procedure.

For safety, the oxygen device has to be removed and turned away from the patient. Oxygen supports combustion, and a fire may result if shock is delivered
A newly diagnosed diabetic patient is started on a two-dose insulin protocol combination of short-acting and intermediate-acting insulin injected twice daily. What portion of the total dose is given before breakfast and what portion before dinner?

a. 1/3 before breakfast and 2/3 before dinner
b. 2/3 before breakfast and 1/3 before dinner
c. Half before breakfast and half before dinner
d. ¾ before breakfast and ¼ before dinner
B – 2/3 before breakfast and 1/3 before dinner

Initially, the two-dose insulin protocol is 2/3 of the dose before breakfast and 1/3 before dinner. Any future changes in ratios are based on results of blood glucose monitoring.
Which of the following foods would be appropriate for a patient w/ acute ulcerative colitis?

a. Diet cola and cashew nuts
b. Corn and mushrooms w/ broccoli
c. Whole-grain cereal and milk
d. Apple sauce and graham crackers
D – apple sauce and graham crackers

The diet should consist of low-fiber (low residue) meals. Avoid foods such as whole-wheat grains, nuts, and fresh fruits and vegetables. Often, lactose-containing foods are poorly tolerated. Caffeine and alcohol should also be avoided.
When obtaining the history of a 24-year old patient w/ type 1 diabetes, the nurse expects to identify the presence of:

a. Edema
b. Anorexia
c. Weight loss
d. Hypoglycemic episodes
C – weight loss

Protein and lipids are broken down because carbohydrates can’t be used by the cells, resulting in weight loss and muscle wasting. Hyperglycemia (not hypoglycemia) is associated w/ both type 1 and type 2 diabetes.
A nurse is providing dietary teaching to a patient w/ PUD. Which of the following patient statements indicate an understanding of the teaching?

a. “a bland diet is recommended for me”
b. “I can drink alcohol as long as I’ve eaten enough foods”
c. “I have to eat six smaller meals a day”
d. “I can have a light snack during bedtime”
A – “a bland diet is recommended for me”

A bland, non-irritating diet is recommended during acute symptomatic phase of PUD.

Bedtime snacks are avoided because they may stimulate gastric acid secretion.

Eating six smaller meals may help, but this regimen is no longer a regular part of therapy. This practice may actually stimulate gastric acid secretion.

Patients should avoid alcohol and tobacco because of their stimulatory effects on gastric acid secretion.
A patient is diagnosed w/ DKA. The nurse identifies that the elevated ketone level present w/ this condition is caused by the breakdown of:

a. Fats
b. Protein
c. Potassium
d. Carbohydrates
A – fats

Breakdown of fats in the cells results in free fatty acids in the liver, which then causes formation of ketone bodies.

Protein metabolism results in nitrogenous waste production, causing elevated BUN.
A 65 year old patient in the acute care facility is presenting signs and symptoms of influenza. To confirm this diagnosis, the nurse would assess for all of the following signs or symptoms except:

a. Fatigue
b. Weakness
c. Night sweats
d. Fever
C. Night sweats

Night sweats is a classical symptom of TB
A nurse is teaching the patient how to mix regular insulin with NPH insulin in the same syringe. Which of the following, if performed by the patient, indicates the need for further teaching?

a. Withdraws the NPH insulin first
b. Withdraws the regular insulin first
c. Injects air into the NPH insulin vial first
d. Injects the amount of air equal to the required dose into the vial
A – withdraws the NPH insulin first

When preparing a mixture of regular insulin w/ another insulin preparation, the regular insulin is withdrawn first to avoid contaminating the vial of regular insulin w/ the other type.
A nurse is doing an assessment on a patient in the cardiac/telemetry unit. Which of the following assessment findings would indicate a possible right-sided heart failure?

a. Crackles in the lungs
b. Productive cough
c. Swelling in the lower leg
d. Weak peripheral pulses
C. Swelling in the lower leg

Right-sided heart failure is characterized by circulatory congestion such as jugular vein distention, edema in the extremities, and ascites

Left-sided heart failure is characterized by weak peripheral pulses, crackles, and productive cough
A nurse is teaching the patient about medication instructions on taking levothyroxine (synthroid). The nurse tells the patient to take the medication:

a. With food
b. On an empty stomach
c. At lunchtime
d. At bedtime w/a snack
B – on an empty stomach

levothyroxine (synthroid) should be taken on an empty stomach to enhance absorption.

Dosing should be done in the morning before breakfast.
A patient is presented to the emergency department w/ sharp, severe abdominal pain. Upon palpation, the patient’s abdomen is rigid and board-like. The patient maintains a side-lying position w/ the knees drawn up to the chest. The nurse should report to the physician that the patient is experiencing which specific complication of peptic ulcer disease (PUD)?

a. Hemorrhage
b. Perforation
c. Obstruction
d. Intractability
B – perforation.

Perforation occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away. Sudden, sharp pain begins in the mid-epigastric area and spread over the entire abdomen. The abdomen is tender, rigid, and board-like and assuming a “fetal” position decreases the tension of the abdominal muscles.
A nurse is providing medication instructions on a patient taking levothyroxine (synthroid). The nurse instructs the patient to notify the healthcare provider if which of the following occurs?
a. Excessive dry skin
b. Cold intolerance
c. Fatigue
d. Tremors
D – tremors

Excessive doses of levothyroxine (synthroid) can produce signs and symptoms of hyperthyroidism (tachycardia, chest pain, tremors, nervousness, heat intolerance, and sweating). The patient should notify the physician if experiencing those symptoms.
A nurse is ordered to administer medications for a patient diagnosed w/ gastritis. Which of the following medications should the nurse question?

a. Propranolol (inderal)
b. Ibuprofen (Motrin)
c. Cyanocobalamin (vitamin b12)
d. Ranitidine (zantac)
B – ibuprofen (motrin)

Patients w/ gastritis should avoid drugs such as corticosteroids, NSAIDs (aspirin, ibuprofen , naproxen).

Vitamin B12 is used to prevent pernicious anemia in patients w/ gastritis.

Ranitidine (zantac) is used to block gastric secretions.
A patient w/ type 2 diabetes is prescribed to take a sulfonylurea drug, glipizide (glucotrol). Which of the following medications of the patient would cause or contribute to hyperglycemia?

a. Prednisone
b. Atenolol
c. Lisinopril
d. Ibuprofen
A – prednisone

Prednisone may cause or worsen hyperglycemia in patients taking sulfonylureas. All the other medications cause or worsen hypoglycemia symptoms in patients taking sulfonylureas.
A nurse in the emergency department is doing an assessment on an older adult patient. Which of the following interventions should the nurse perform to assess for left-sided heart failure?

a. Ask patient about weight gain
b. Observe for presence of ascites
c. Assess for edema in the extremities
d. Ask if patient can perform normal ADLs without fatigue or dyspnea
D. Ask if patient can perform normal ADLs without fatigue or dyspnea

With left-sided heart failure, cardiac output is diminished, leading to impaired tissue perfusion, and unusual fatigue. Many patients experience weakness or fatigue with activity or having a feeling of heaviness in their arms or legs
When caring for patients who are suspected to have the flu, nurses should know that the condition is most contagious at what time period?

a. 24 hours after the symptoms occur
b. 24 hours before the symptoms occur
c. 3 – 5 days before the symptoms occur
d. 2 – 3 days before the symptoms occur
B. 24 hours before symptoms occur

The condition is most contagious from 24 hours before the symptoms occur and up to 5 days after they begin
A nurse in the cardiac/telemetry department is doing an assessment on a patient diagnosed with heart failure. Which of the following interventions should the nurse perform to best assess for complications of right-sided heart failure?

a. Monitor weight
b. Assess and observe for edema in the extremities
c. Observe / monitor sputum consistency
d. Assess lungs for any crackles / wheezing
A. Monitor weight

In ambulatory patients, edema is in the ankles and legs. When patients are restricted to bedrest, edema accumulates in the sacrum. Edema is an extremely unreliable sign of HF, and therefore accurate daily weights are needed to document fluid retention. Weight is the most reliable indicator of fluid gain or loss
A patient w/ type 1 diabetes is admitted to the emergency department. Which of the following respiratory patterns of the patient requires immediate action?

a. Shallow respirations alternating w/ long expirations
b. Deep, rapid respirations w/ long inspirations
c. Regular depth of respirations w/ frequent pauses
d. Short respirations and inspirations
B – deep, rapid respirations w/ long inspirations

Deep, rapid respirations is indicative of Kussmaul’s respirations, which occur in metabolic acidosis. The respirations increase in depth and rate, and the breath has a “fruity” or acetone-like odor.
A nurse is caring for a patient diagnosed w/ ulcerative colitis. Which of the following aassessment findings would the nurse report to the physician?

a. Rebound tenderness
b. Bloody stool
c. Weight loss
d. Malaise
A – rebound tenderness

Rebound tenderness may indicate peritonitis.

Bloody stool, weight loss, and malaise are common findings in patients w/ ulcerative colitis.
Which of the following tests would best diagnose heart failure?

a. MUGA
b. Echocardiogram
c. BNP
d. BUN / creatinine
B. Echocardiogram

Echocardiography is considered the best tool in diagnosing heart failure. Cardiac valvular changes, pericardial effusion, chamber enlargement, and ventricular hypertrophy can be diagnosed using this non-invasive technique. It can also be used to determine ejection fraction
ACE inhibitors may be prescribed for patients w/ diabetes to reduce vascular changes and possibly prevent or delay the development of:

a. COPD
b. Pancreatic cancer
c. Cerebrovascular accident
d. Renal failure
D – renal failure

Renal failure frequently results from the vascular changes associated w/ diabetes. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy.
A nurse is teaching a patient w/ an ileostomy about proper care. Which of the following should be included in the teaching?

a. Eat high-fiber foods to aid in food digestion
b. Laxatives may be used if no stool has passed
c. Use a pectin-based skin barrier to protect skin from contact w/ ostomy contents
d. Change the entire pouch system every 3 – 4 weeks
C – use a pectin-based skin barrier to protect skin from contact w/ ostomy contents

High-fiber foods should be used w/ caution and may be eliminated from diet if they cause severe problems (diarrhea, constipation, blockage).

Laxatives or enemas shouldn’t be used. The patient should usually have loose stool and should contact the physician if no stool has passed for 6 – 12 hours.

The entire pouch system should be changed every 3 – 7 days.
A nurse is assessing a patient with heart failure. The lung sounds commonly associated with heart failure are:

a. Bronchial
b. Coarse crackles
c. Fine crackles
d. Friction rubs
C. Fine crackles

Fine crackles are caused by fluid in the alveoli and commonly occur in patients with heart failure. Coarse crackles are typically caused by secretion accumulated in the airways. Friction rub occurs with pleural inflammation
The nurse is caring for a patient w/ diabetes. Which of the following medications of the patient may cause a complication w/ the treatment plan of the patient w/ diabetes?

a. ACE inhibitors
b. Steroids
c. Aspirin
d. Sulfonylureas
B – steroids

Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism.
An ICU nurse is caring for a 65 year old patient diagnosed with COPD who had a recent aspiration event. Once the patient is in a stable condition, the primary healthcare provider ordered the nurse to administer medications to the patient. Which of the following medications should the nurse question?

a. Cimetidine (Tagamet)
b. Guaifenesin (Robitussin)
c. Salmeterol (Serevent)
d. Fluticasone (Flovent)
A. Cimetidine (Tagamet)

Older adult patients who have a chronic lung disease, has had a recent aspiration event, and uses drugs that increase gastric pH (histamine [H2] blockers – Cimetidine, or antacids) are at a high risk for acquiring pneumonia (hospital-acquired)
Which of the following drugs reduce cardiac preload in patients with heart failure?

a. Enalapril (vasotec)
b. Furosemide (lasix)
c. Digoxin (lanoxin)
d. Dobutamine (dobutrex)
B. Furosemide (lasix)

Ventricular fibers contract less forcefully when they are overstretched, such as in heart failure. Diuretics enhance renal excretion of sodium and water by reducing circulating blood volume, decreasing preload, and reducing systemic and pulmonary congestion
Which of the following classifications of medication should not be administered for a patient w/ diverticulitis?

a. Broad-spectrum antibiotics
b. Analgesics
c. Laxatives
d. Anticholinergics
C – laxatives

Laxatives and enemas are avoided because they increase intestinal motility.
A diabetic client has been diagnosed w/ HTN and the physician has prescribed a beta blocker (atenolol) for the patient. When performing patient teaching, it is important for the nurse to inform the patient that adding the beta blocker to the current regimen can cause:

a. Impotence
b. Hyperglycemia
c. Hypoglycemia
d. Excessive thirst
C – hypoglycemia

There is a direct interaction between the effects of insulin and beta blockers. The nurse should be aware that there is a potential for increased hypoglycemia effects of insulin when a beta blocker is added to the regimen.
A nurse is teaching a patient w/ GERD about drug therapy. Which of the following patient statements indicate a need for further teaching regarding antacid therapy?

a. “I need to take this drug for a long time to manage my heartburn”
b. “I will have to take it 1 hour before I eat”
c. “these medications can cause constipation or diarrhea”
d. “I can take these at bedtime”
A – “I need to take this drug for a long time to manage my heartburn”

Antacids increase LES pressure and therefore are not given for long-term use.

Antacids work best if stomach is empty.

Aluminum products produce constipation, and magnesium products induce diarrhea.
A patient with HF complains of having a headache soon after taking his Nitrate medication. The nurse taking care of the patient would administer which of the following drugs?

a. Digoxin
b. Acetaminophen
c. Furosemide
d. Aspirin
B. Acetaminophen

Patients taking Nitrates for HF may initially report headache. Acetaminophen (Tylenol) can be given to help relieve discomfort
A nurse is assessing a patient diagnosed w/ acute pancreatitis for pain. What type of pain is consistent w/ the patient?

a. Severe and constant pain located in the left lower quadrant and radiating to the groin
b. Burning and aching, located in the epigastric area and radiating to the back
c. Burning and aching, located in the left lower quadrant and radiating to the hip
d. Severe and constant pain located in the epigastric area and radiating to the back
D – severe and constant pain located in the epigastric area and radiating to the back

Clinical manifestations of acute pancreatitis vary widely and depend on severity of inflammation. Typically, a patient is diagnosed after presenting w/ severe abdominal pain in the mid-epigastric area or left upper quadrant and radiates to the back, left flank, or left shoulder.
Which of the following should be the priority nursing diagnosis for a patient w/ ulcerative colitis?

a. Diarrhea
b. Imbalanced nutrition: less than body requirements
c. Disturbed body image
d. Activity intolerance
A – diarrhea

The major concern for a patient w/ ulcerative colitis is the occurrence of frequent, bloody diarrhea and fecal incontinence from tenesmus (straining).
Which of the following assessment findings isn’t present in a patient w/ Crohn’s disease?

a. Weight loss
b. Diarrhea
c. Weight gain
d. Fever
C – weight gain

Most patients w/ Crohn’s disease have weight loss, diarrhea, and low-grade fever.

Fever is common w/ fistulas, abscesses, and severe inflammation.
A patient was admitted in the ICU for signs and symptoms of pulmonary edema. Initial assessment findings by the nurse include fine crackles at both bases of the lungs, disorientation, productive cough with pink-tinged sputum, and dyspnea. Which of the following should the nurse do first?

a. Continue with the assessment
b. Administer 2L oxygen via nasal cannula
c. Position the patient in supine position w/patient’s legs elevated
d. Administer high-flow oxygen at 5 – 6L by facemask
D. Administer high-flow oxygen at 5 – 6L by facemask

For pulmonary edema, the priority nursing action is to administer high-flow oxygen therapy at 5 – 6L/min by facemask or at 10 – 15L/min by non-rebreather mask with reservoir.
A patient diagnosed w/ cirrhosis and ascites is scheduled for paracentesis. The nurse taking care of the patient should note which of the following signs or symptoms as complications of the procedure?

a. Hypotension and tachycardia
b. Dyspnea and chest pain
c. Dehydration and confusion
d. Hypertension and bradycardia
A – hypotension and tachycardia

In paracentesis, rapid, drastic removal of ascitic fluid leads to decreased abdominal pressure, which may contribute to vasodilation and shock. The nurse should observe for impending signs and symptoms of shock (e.g., hypotension and tachycardia)
All of the following are common complications of pneumonia except:

a. CO2 retention
b. Atelectasis
c. Hypoxemia
d. Cyanosis
A. CO2 retention

In pneumonia, oxygen is the gas exchange affected most; therefore hypoxemia is the primary problem. Carbon dioxide retention is not common in pneumonia.
A nurse is ordered to administer a single oral dose of ranitidine (zantac) for a patient w/ peptic ulcer disease. At which time period should the nurse give the medication?

a. In the morning
b. At bedtime
c. Before meals
d. After meals
B – at bedtime

H2 blockers (ranitidine) blocks histamine-stimulated gastric secretions. Bedtime administration of the drug suppresses nocturnal acid production.
A nurse is reviewing the lab values of his patient recently diagnosed w/ cirrhosis. The patient’s low albumin level is indicated by which physiological factor?

a. Decreased clotting factors
b. Jaundice
c. Clay-colored stools
d. Peripheral edema
D – peripheral edema

When albumin levels are low, osmotic pressure is decreased, which can lead to peripheral edema. Jaundice and clay-colored stools are indicated by an elevated bilirubin level. Decreased clotting factors are caused by prolonged PT-INR.
A nurse is doing an admission assessment on a patient with atherosclerosis. The patient’s blood pressure was 160/100, what should the nurse do next?

a. Assess BP on the other arm
b. Call physician and request an order for antihypertensive medication
c. Place the crash cart close by and continue on with the assessment
d. Ask the patient about recent activities
A. Assess BP on the other arm

Because of high incidence of hypertension in patients with atherosclerosis, blood pressure should be assessed on both arms. Perform a complete cardiovascular assessment because associated heart disease is often present
A nursing student is preparing her patient for paracentesis. Before the procedure, the nursing student should put the patient into which of the following positions?

a. Side-lying
b. Supine
c. Upright
d. Upside-down
C – upright

Patient safety procedures for paracentesis include monitoring vital signs, weight, asking the patient to void before the procedure to prevent bladder injury, and positioning the patient in the bed w/ the head of the bed elevated.
Aluminum hydroxide is prescribed for the patient w/ peptic ulcer disease. The nurse should assess for which side effect of the drug?

a. Diarrhea
b. Constipation
c. Polyuria
d. Fluid retention
B – constipation

Aluminum hydroxide causes constipation. If patient experiences constipation, consider alternating w/ magnesium antacid.
A nurse is reviewing diagnostic tests for a patient w/ suspected diverticulitis. Which of the following diagnostic tests should the nurse question?

a. CT scan
b. Abdominal ultrasound
c. WBC count
d. Barium enema
D – barium enema

Barium enema is contraindicated in patients w/ diverticulitis because it can cause bowel perforation.
The nurse is teaching a patient w/ acute pancreatitis about pain management. The patient shows understanding of the teaching when she states that pain will be reduced if the patient avoids which position?

a. Leaning forward
b. Lying flat
c. Side-lying, drawing legs up to the chest
d. Sitting up, w/ feet elevated
B – lying flat

In pancreatitis, pain is aggravated when the patient is lying supine. Helping the patient assume a side-lying position (w/ legs drawn up to the chest) may decrease abdominal pain of pancreatitis.
Which of the following interventions is the most preferred method in controlling complications of atherosclerosis?

a. Prescribed HMG-CoA reductase inhibitor drugs (statins)
b. Arterial revascularization
c. Nutrition / lifestyle changes
d. Anti-platelet agents
C. Nutrition / lifestyle changes

Interventions for patients with atherosclerosis or those at high risk for the disease focus on lifestyle changes. Nutrition is one of the most important parts of the risk-reduction plan.

If lipoprotein levels don’t improve after lifestyle changes, the healthcare provider may prescribe drug therapy to lower cholesterol and/or triglycerides
Which of the following diagnostic results best confirm presence of peptic ulcer disease on a patient?

a. Elevated WBC
b. Stool specimen positive for occult blood
c. Decreased hemoglobin and hematocrit
d. Positive H. pylori EGD biopsy
D – positive H. pylori EGD biopsy

The major diagnostic test for PUD is EGD. Direct visualization allows for taking specimens for H. pylori testing and biopsy and for ruling out gastric cancer.
A patient was admitted to the emergency department for severe abdominal pain, and nausea. Vital signs are T = 100°F, R=40, BP= 140/56, P=76. History includes chronic alcohol use for 10 years. The patient was diagnosed w/ acute pancreatitis. Based on the data presented, which of the following should be the primary concern for the patient?

a. Inadequate nutrition
b. Electrolyte imbalance
c. Acute pain
d. Ineffective coping
C – acute pain

In acute pancreatitis, the main focus of nursing care is aimed at controlling pain by interventions that decrease GI tract activity, thus decreasing pancreatic stimulation.
A patient complains of recent muscle cramps, weakness and abdominal pain after taking her medication Simvastatin (Zocor). Recent lab work results show elevated liver enzyme levels. Which of the following should the nurse anticipate to do?

a. Decrease the dose of the drug
b. Increase the dose of the drug
c. Withhold the drug
d. Nothing, as those symptoms are expected effects of the drug
C. Withhold the drug

Statins (e.g. Simvastatin) are contraindicated in patients with active liver disease or during pregnancy because they can cause muscle myopathies, and marked decrease in liver function. Statin drugs are D/C’ed if the patient has muscle cramping or elevated liver enzymes
A nurse is assessing a patient experiencing signs and symptoms of cholecystitis. Which area should the nurse anticipate the location of pain?

a. Left upper quadrant, radiating to the left scapula and shoulder
b. Left lower quadrant, radiating to the legs
c. Right upper quadrant, radiating to the right scapula and shoulder
d. Right lower quadrant, radiating to the back
C – right upper quadrant, radiating to the right scapula and shoulder

In cholecystitis, pain may be described as indigestion of varying intensity, ranging from mild, persistent ache to steady, constant pain in the right upper quadrant and may radiate to the right shoulder or scapula.
A nurse is caring for a patient who went for conventional open surgery for sliding hiatal hernia. Which of the following should be the priority nursing intervention?

a. Place patient on soft diet following surgery
b. Observe for fever, nausea, vomiting
c. Elevate HOB at least 30 degrees
d. Administer anti-reflux medications PRN
C – elevate HOB at least 30 degrees

The primary focus of care after conventional surgery is the prevention of respiratory complications. Elevate the HOB at least 30 degrees to lower the diaphragm and promote lung expansion.

All the other options are related to postoperative instructions for patients having laparoscopic Nissen Fundoplication (LNF).
A nurse is teaching a patient about maintaining a healthy heart. The nurse should include which point in her teaching?

a. Use alcohol in moderation
b. Smoke in moderation
c. Consume diet high in saturated fats and low in cholesterol
d. Exercise 1 – 2 times per week
A. Use alcohol in moderation

The nurse should advise the patient that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in saturated fats, and a sedentary lifestyle are all risk factors for cardiac disease. The patient should be encouraged to quit smoking, exercise 3 – 4 times per week, and consume a diet low in saturated fats and cholesterol
Which type of ulcer is presented by the patient who feels pain 2 hours after a meal?

a. Duodenal ulcer
b. Gastric ulcer
c. Stress ulcer
d. Ischemic ulcer
A – duodenal ulcer

Patients w/ duodenal ulcer experience pain 1 ½ - 3 hours after a meal and relieved w/ ingestion of food.

Pain in gastric ulcer usually occurs 30 – 60 minutes after a meal and is worsened w/ ingestion of food.

Ischemic ulcer is a type of stress ulcer that occurs after an acute medical crisis or trauma, such as head injury or sepsis.
The nurse is caring for a patient who just returned from esophagogastroduodenoscopy (EGD) procedure. Which of the following is not included in the plan of care regarding the patient?

a. Monitor for signs of bleeding
b. Teach patient not to drive after the procedure
c. Use cough drops to relieve throat discomfort
d. Offer fluids for fluid and electrolyte replacement
D – offer fluids for fluid and electrolyte replacement

The priority for care is to prevent aspiration. Don’t offer fluids or food by mouth until gag reflex is intact. Monitor signs of perforation, such as pain, bleeding, or fever. Teach patient not to drive for at least 12 hours after procedure because of sedation. Cough drops can be used to relieve throat discomfort.
The nurse is performing discharge teaching for a patient diagnosed w/ PUD about an antacid medication, Mylanta (magnesium hydroxide and aluminum hydroxide). Which of the following statements should the nurse include in the teaching?

a. Drug should be taken 1 – 2 hours before meals
b. It is the drug of choice for treating acid-related disorders
c. It has a high sodium content
d. It can be taken w/ other medications
C – it has a high sodium content

This antacid has a high sodium and magnesium content which cannot be excreted by the kidneys by poorly functioning kidneys, thus causing toxicity.

Drug should be taken 2 hours after meals and at bedtime.

Proton pump inhibitors are the drug of choice for treating acid-related disorders.

Drug shouldn’t be given w/in 1 – 2 hours of other drugs because it interferes w/ absorption of the other drugs.
Which of the following patients is at highest risk for developing primary hypertension?

a. 50 year old man with a suspected brain tumor and renal disease
b. 30 year old woman who uses estrogen-containing oral contraceptives
c. 50 year old woman with Cushing’s disease
d. 70 year old man with family history of hypertension
D. 70 year old man with family history of hypertension

A family history of hypertension is a major risk factor for developing primary hypertension
A nurse is assessing a patient who underwent esophagogastroduodenoscopy (EGD). Which of the following would indicate a need for immediate intervention by the nurse?

a. Fever
b. Absent gag reflex
c. Sore throat
d. Drowsiness
A – fever

Drowsiness, sore throat, and absent gag reflex are normal findings after the procedure. Pain, bleeding, and fever are signs of perforation which is a complication of EGD.
The nurse is doing an assessment on the following patients. Which of the following requires immediate intervention?

a. Patient presented w/ ribbon-like stools
b. Patient presented w/ rigid, broadlike abdomen
c. Patient who complains of epigastric pain after eating
d. Patient presented w/ hypoactive bowel sounds
B – patient presented w/ rigid, broadlike abdomen

Rigid, broadlike abdomen is a sign of peritonitis, which is a life threatening condition.
The nurse is completing a care plan for a patient who underwent a laparoscopic Nissen fundoplication (LNF). Which of the following food choices should the nurse include in the care plan?

a. Broccoli, roasted chicken, diet cola
b. Mashed potatoes, pudding, and milkshake
c. Egg salad, whole wheat bread, decaffeinated coffee
d. Garden salad, steamed chicken, orange juice
B – mashed potatoes, pudding, and milkshake

Postoperative instructions for patients having LNF include having a soft diet for about a week, including mashed potatoes, puddings, custards, and milkshakes; avoid carbonated beverages, tough foods, and raw vegetables that are difficult to swallow.
A nurse is assessing a patient who just returned to the unit following an EGD biopsy for H. pylori. Which of the following should the nurse note as a complication of the procedure?

a. Absent gag reflex
b. Drooling
c. Sore throat
d. Fever
D – fever

Patients who underwent EGD should be monitored for signs of perforation, such as pain, bleeding, and fever.
The nurse is providing discharge teaching to a patient w/ cirrhosis and his family member. Which of the following patient statements indicate patient understands the teaching?

a. “I can consume alcohol in moderation and only w/ food”
b. “I can increase my daily dose of lactulose”
c. “A healthy diet, exercise, and adequate rest will help cure liver damage from cirrhosis”
d. “I will take aspirin instead of Tylenol for pain”
B – “I can increase my daily dose of lactulose”

Family members should be taught about how to recognize signs of PSE and that it’s necessary and safe to increase the daily lactulose at the first sign of PSE.

Patients w/ cirrhosis should avoid alcohol and all OTC drugs, especially NSAIDs.

Cirrhosis is the extensive, irreversible scarring of the liver, usually caused by chronic reaction to hepatic inflammation and necrosis.
Patients who experience muscle pain, cramping, or burning while exercising but relieved with rest is in what stage of peripheral arterial disease?

a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
B. Stage 2

Patients with stage 2 PAD experience intermittent claudication. Usually they can walk only a certain distance before a cramping, burning muscle discomfort or pain forces them to stop. The pain stops at rest. Symptoms are reproducible with exercise
A nurse is reviewing the plan of care for a patient w/ Crohn’s disease. Which of the following would be included in the plan of care for the patient?

a. Antidiarrheal medications PRN
b. Provide a high-calorie, high-fiber diet
c. Order for lactulose
d. High-protein milkshakes if food isn’t tolerated
A – antidiarrheal medications PRN

To provide symptomatic management of diarrhea, antidiarrheal drugs may be prescribed. A high-fiber diet, lactulose and foods containing milk products may promote diarrhea and are contraindicated in patients w/ the condition.
A nurse is assessing a patient admitted for peptic ulcer disease. The patient is ordered to take ranitidine (zantac) as part of her drug regimen. Which of the following medications of the patient would have a potential drug interaction w/ the newly ordered drug (ranitidine)?

a. Metoprolol (Lopressor)
b. Aluminum hydroxide (Amphojel)
c. Alprazolam (Xanax)
d. Candesartan (Atacand)
B – aluminum hydroxide (amphojel)

Antacids can interact w/ ranitidine and interfere w/ absorption. Drugs should not be given w/in 1 – 2 hours of antacids.
A nurse educator is teaching a group of nursing students about problems of the biliary system and pancreas. Which of the following statements about the incidence/prevalence of pancreatitis should the nurse include in the teaching?

a. African-american men over the age of 40 are at risk for developing cholecystitis
b. Pancreatic attacks are most common during the school year, usually days before and after final exams
c. Pancreatic attacks are most common during holidays and vacations
d. Somatostatins are avoided in patients undergoing ERCP to prevent incidence of acute pancreatitis
C – pancreatic attacks are most common during holidays and vacations

Pancreatic attacks are most common during holidays and vacations when alcohol consumption is usually high, especially in men.

To help reduce incidence of acute pancreatitis in ERCP, somatostatins and its analogue octreotide are used. The drugs appear to have an anti-inflammatory and cycloprotective properties.
A patient is diagnosed w/ acute gastritis. Which of the following assessment findings would need an immediate nursing action?

a. Patient complains of feeling pain after meals
b. Epigastric discomfort
c. Stools have black, tarry appearance
d. Heartburn
C – stools have black, tarry appearance

Black, tarry stools indicate upper GI bleeding. Hemorrhage can occur if erosion extends to the blood vessels.
To confirm a diagnosis of DVT on a patient, the nurse would anticipate an order for what specific blood test?

a. CKMB
b. Troponin
c. D-dimer
d. CBC
C. D-dimer

The D-dimer test is a global marker of coagulation activation and measures fibrin degradation products produced from clot breakdown. The test is used for diagnosis of DVT
A nurse is doing a patient-discharge teaching with a patient diagnosed with COPD about his medication Theophylline (Theo-Dur). Which of the following restrictions should the nurse teach the patient regarding the drug?

a. Avoid caffeine
b. Avoid foods that contain tyramine
c. Avoid high-carb foods
d. Avoid any dairy products
A. Avoid caffeine

The drug is acts like caffeine to cause bronchodilation by relaxing bronchiolar smooth muscles. Taking the drug with caffeine increases the risk for toxicity
A patient w/ inflammatory bowel disease tells the nurse he wants to order food. Which of the following foods should the nurse suggest?

a. Fresh fruit salad and whole milk
b. Chunky peanut butter on whole-wheat bread
c. Chili with French fries
d. Scrambled eggs and apple sauce
D – scrambled eggs and apple sauce

Low-residue foods produce less fecal waste, decreasing bowel contents and irritation. Often, lactose-containing foods are poorly tolerated.
Which of the following nursing diagnosis is appropriate for a patient with COPD taking Corticosteroids?

a. Anxiety
b. Risk for infection
c. Risk for falls
d. Risk for disturbed sleep pattern
B. Risk for infection

COPD patients taking anti-inflammatory corticosteroids are at risk for developing an infection

(Fluticasone [Flovent] – reduces local immunity and increases risk for local infections)

(Prednisone [Deltasone] – reduces all protective inflammatory process, increasing the risk for infection)
Which of the following pain manifestation is presented on a patient w/ GERD?

a. Burning sensation that tends to move up and down the chest
b. Chest pain that mimics angina
c. Rapid onset of epigastric pain and discomfort
d. Constant right upper quadrant pain
A – burning sensation that tends to move up and down the chest

Patients w/ GERD presents w/ pain described as a substernal burning sensation that tends to move up and down the chest in a wavelike fashion.

Chest pain that mimics angina is one of the key features of paraesophageal (rolling) hiatal hernias.
A nurse is doing a patient teaching procedure to a patient about SubQ anticoagulation therapy. Which patient statement indicates the need for further teaching?

a. “I will use an electric razor when shaving”
b. “I will apply pressure and massage the injection site to increase drug absorption”
c. “I can elevate my legs when I’m sitting in the chair”
d. “oral contraceptives should be avoided”
B. “I will apply pressure and massage the injection site to increase drug absorption”

Massaging the area should be avoided to prevent bruising

Supportive therapies for DVT include bed rest and elevation of extremity. Teach patient to elevate his/her legs when on the bed or chair.
Which assessment is most important for the nurse to perform on a patient with COPD receiving Albuterol (Ventolin)?

a. Measure intake and output
b. Monitor pulse and BP
c. Monitor temperature
d. Assess for mental status
B. Monitor pulse and BP

Albuterol (Ventolin) is a beta adrenergic agonist with a bronchodilating effect. Because adrenergic agonists mimic sympathetic stimulation, the patient must be monitored carefully for cardiac arrhythmias, hypertension, nervousness, and restlessness.
Which of the following should not be included in postoperative instructions for patients having endoscopic therapies for GERD?

a. Place patient in soft diet for 24 hours after the procedure
b. Avoid NSAIDs and aspirin for 10 days
c. Contact healthcare provider if SOB, chest pain, or n/v occurs
d. Don’t allow NG tube insertions for at least one month
A – place patient in soft diet for 24 hours after the procedure

Patients should remain on clear liquids for 24 hours after the procedure. After the first day, a soft diet (custard, pureed vegetables, mashed potatoes) may be consumed.

NG tubes aren’t allowed for at least 1 month because the esophagus could be perforated.
A patient w/ angina is discharged w/ a prescription for nitroglycerin. Which discharge instruction should the nurse include in the plan?

a. Take one every 15 minutes if pain occurs
b. Place medication in a brown bottle
c. Crush medication and take w/ water for faster absorption
d. Increase the dosage if pain persists for more than 15 minutes
B – place medication in a brown bottle

Nitroglycerin should be stored in a container at room temperature, away from moisture, heat, and direct light.

One tablet should be used every 5 minutes and if the pain doesn’t subside for 15 minutes, seek medical attention. The drug should be taken sublingually and shouldn’t be crushed.
The nurse is taking care of a patient on continuous IV heparin therapy. The patient’s aPTT results are: aPTT 100 seconds, control 35 seconds. Which intervention should the nurse anticipate?

a. Decrease the infusion rate
b. Increase the infusion rate
c. Continue the same infusion rate
d. Stop the infusion
A. Decrease the infusion rate

The therapeutic range of the aPTT should be 1.5-2 times greater than the control. The patient’s aPTT level is high and continuing the current rate could initiate bleeding. The infusion rate should be decreased, according to the prescribed protocol, until the APTT results have decreased.
A nurse is performing a patient teaching session w/ a patient about foods that are low in fat and cholesterol. Which food selection should the nurse include in the teaching?

a. Shrimp w/ rice
b. Turkey breast
c. Spaghetti w/ meat sauce
d. Macaroni and cheese
B – turkey breast

Turkey contains the least amount of fats and cholesterol.
The primary care provider ordered lisinopril and furosemide for a patient w/ hypertension. The nurse taking care of the patient should:

a. Question the order
b. Administer the medication
c. Hold the lisinopril
d. Hold the furosemide
B – administer the medication

An ACE inhibitor is frequently given together w/ a diuretic such as Lasix for hypertension.
The physician ordered regular insulin (humulin R) and insulin glargine (lantus) to be administered at the same time for a patient w/ diabetes. The nurse taking care of the patient should:

a. Draw up the lantus insulin first then the regular insulin in the same syringe
b. Question the order
c. Shake the insulin vials before drawing up the prescribed amount
d. Draw up the insulins in two different syringes
D – draw up the insulins in two different syringes

Lantus insulin can’t be mixed w/ other insulin types but can be taken by the patient who is also taking a dose of regular insulin.
A patient is admitted and diagnosed w/ PUD. Which of the following assessment findings should be reported immediately?

a. Pulse 82, respirations 18
b. BP 120/86, pulse 56
c. BP 82/60, pulse 120
d. Pulse 80, respirations 20
C – BP 82/60, pulse 120

Decreased BP and increased HR are associated w/ bleeding and shock.
The nurse is developing a care plan for a patient w/ a newly placed ileostomy. Which of the following should be the priority nursing diagnosis for the patient?

a. Risk for impaired skin integrity r/t skin irritation from ostomy appliance
b. Disturbed body image r/t presence of ostomy
c. Deficient knowledge of care r/t recent ostomy placement
d. Deficient fluid volume r/t excessive fluid loss from ostomy
D – deficient fluid volume r/t excessive fluid loss from ostomy

The ileostomy begins to drain w/in 24 hours after surgery at more than 1L per day. Fluids should be replaced by adding an additional 500ml or more each day to prevent dehydration.
A nurse administered diphenoxylate hydrochloride and atropine sulfate for her patient diagnosed w/ ulcerative colitis. Which of the following would indicate that the drug is having a therapeutic effect on the patient?

a. Decreased gastric reflux
b. Absence of chest pain
c. Weight gain
d. Decreased diarrhea
D – decreased diarrhea

Diphenoxylate hydrochloride and atropine sulfate (lomotil) is used to manage diarrhea. The drug’s desired effect is to decrease GI motility and the number of diarrhea stools.
A nurse is reviewing a physician’s order for her patient w/ COPD. Which of the following orders should the nurse question?

a. O2 at 5L/min by nasal cannula
b. Solu medrol 125 mg IV push Q6H
c. Darvocet N 100 PO prn for pain
d. Ceftriaxone (rocephin) 1 gram IVPB daily
A – O2 at 5L/min by nasal cannula

The patient w/ COPD uses hypoxemia as a stimulus to breathe. Raising the O2 blood level can suppress the respiratory drive.
The nurse instructs the patient about purse-lip breathing. The patient asks what the purpose of this type of breathing is. Which of the following should be the nurse’s response?

a. Promotes oxygen intake
b. Promotes CO2 elimination
c. Strengthen intercostal muscles
d. Strengthen diaphragm
B – promotes CO2 elimination

Pursed-lip breathing facilitates maximal expiration for COPD patients. It allows better expiration by increasing airway pressure that keeps air passages open during exhalation.
A nurse is performing discharge teaching on a patient w/ TB about drug therapy. Which of the following patient statements indicate understanding of the teaching?

a. “I can go back to work if my first sputum culture comes back negative”
b. “I should not be contagious after 2 – 3 weeks of drug therapy”
c. “I have to take the drugs for 3 months”
d. “I may have to avoid large crowds for a year”
B – “I should not be contagious after 2 – 3 weeks of drug therapy”

The patient is considered not to be contagious after 2-3 weeks of medication therapy. Depending on the situation, drug therapy can last from 6 – 12 months. 3 negative sputum cultures are needed before the patient can go back to work.
Which of the following test would confirm a diagnosis of TB?

a. Chest x-ray
b. TB skin test
c. Bronchoscopy
d. Sputum culture
D – sputum culture

TB is definitively diagnosed through culture and isolation of mycobacterium tuberculosis. A presumptive diagnosis is made based on a TB skin test, chest x-ray, and bronchoscopy.
A patient is presented to the emergency department w/ flu-like symptoms. Which of the following would be the least helpful recommendation for the patient?

a. Get a flu-shot immediately
b. Get plenty of rest
c. Increase fluid intake
d. Take antipyretic for fever
A – get a flu-shot immediately

Immunization against influenza is a prophylactic (preventive) measure and isn’t used to treat flu-like symptoms.
A nurse is performing a respiratory focus assessment on a patient w/ COPD. Which of the following assessment findings indicate deterioration in ventilation?

a. Bilateral coarse crackles
b. Rapid, shallow respirations
c. “barrel” chest
d. Cyanosis
B – rapid, shallow respirations

Increased respiration rate and decreased depth of respiration indicate decline in ventilation.
Cyanosis may be present w/ some but not all patients. Barrel chest is a common feature of COPD. During exacerbation, coarse crackles are expected to be heard bilaterally throughout the lungs but don’t indicate deterioration of ventilation.